Hepatocellular carcinoma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2] Mohamad Alkateb, MBBCh [3]
Overview
Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor. If the cancer is inoperable, the disease is usually deadly within 3 to 6 months. The survival rate of hepatocellular carcinoma is less than 50 percent.
Natural History
Without treatment, the patient will develop symptoms of jaundice, ascites, cachexia, right upper quadrant abdominal pain, nausea, and vomiting, which will eventually lead to death.
Complications
Complications that can develop as a result of hepatocellular carcinoma include the following:
- Jaundice
- Ascites
- Cachexia
- Coagulopathy
- Erythrocytosis
- Hypercalcemia
- Hypertension
- Watery diarrhea
- Hypoglycemia
- Hypercholesterolemia
The following complications may result from TAE/TACE therapy of the tumour:[1][2][3][4]
- Liver rupture
- Liver abscess
- Femoral artery pseudoaneurysm
- Cholecystitis
- Biloma
- Pulmonary embolism
- Partial intestinal obstruction
Common complications of radiofrequency ablation therapy include the following:[5]
- Sepsis
- Hepatic failure
- Intraperitoneal bleeding
- Liver abscess
- Bile duct injury
- Grounding pad burns
Prognosis
Due to its late presentation, the prognosis of hepatocellular carcinoma is poor even with treatment. Without treatment, hepatocellular carcinoma will result in early death. The prognosis depends on the following:[6]
- Operable vs inoperable cancer
- Cancer staging: Size and metastasis play a major role in prognosis
- Patient’s general health
- Time of cancer diagnosis
The survival rate of Hepatocellular carcinoma is less than 50 percent.
Independent predictors of prognosis
- The following parameters are known to be independent predictors of prognosis for hepatocellular carcinoma:[7]
- Alpha fetoprotein (AFP)
- Alkaline phosphatase
- International normalized ratio
- Creatinine
- MELD score > 10
- Number of nodules
- Maximum tumor diameter
- Portal vein thrombosis
- Extra-hepatic metastasis
- Performance status
Prognosis based on staging systems
- The Barcelona Clinic Liver Cancer (BCLC) staging system has the best independent predictive power for survival when compared with the other 6 prognostic systems.[7]
References
- ↑ Tu J, Jia Z, Ying X, Zhang D, Li S, Tian F, Jiang G (2016). "The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma". Medicine (Baltimore). 95 (49): e5606. doi:10.1097/MD.0000000000005606. PMC 5266057. PMID 27930585.
- ↑ Jia Z, Tian F, Jiang G (2013). "Ruptured hepatic carcinoma after transcatheter arterial chemoembolization". Curr Ther Res Clin Exp. 74: 41–3. doi:10.1016/j.curtheres.2012.12.006. PMC 3862201. PMID 24384870.
- ↑ Chung JW, Park JH, Im JG, Han JK, Han MC (1993). "Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma". Radiology. 187 (3): 689–93. doi:10.1148/radiology.187.3.8388567. PMID 8388567.
- ↑ Chung JW, Park JH, Han JK, Choi BI, Han MC, Lee HS, Kim CY (1996). "Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization". Radiology. 198 (1): 33–40. doi:10.1148/radiology.198.1.8539401. PMID 8539401.
- ↑ Rhim H (2005). "Complications of radiofrequency ablation in hepatocellular carcinoma". Abdom Imaging. 30 (4): 409–18. doi:10.1007/s00261-004-0255-7. PMID 15688113.
- ↑ Altekruse, Sean F.; McGlynn, Katherine A.; Reichman, Marsha E. (2009). "Hepatocellular Carcinoma Incidence, Mortality, and Survival Trends in the United States From 1975 to 2005". Journal of Clinical Oncology. 27 (9): 1485–1491. doi:10.1200/JCO.2008.20.7753. ISSN 0732-183X.
- ↑ 7.0 7.1 Marrero JA, Fontana RJ, Barrat A, Askari F, Conjeevaram HS, Su GL, Lok AS (2005). "Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort". Hepatology. 41 (4): 707–16. doi:10.1002/hep.20636. PMID 15795889.